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VOLUME 15 NUMBER 2 • NOVEMBER 2018
83
SA JOURNAL OF DIABETES & VASCULAR DISEASE
PASCAR ROADMAP
– Design special courses reinforcing health staff capacity to
manage hypertension.
– Use an online system to train at least 50 000 certified
nurses and 25 000 certified general physicians to take
appropriate decisions regarding detecting, treating and
controlling hypertension by 2025.
– PASCAR and national cardiac societies will design the
course, and national recertification may be required after
training.
7. Ensure the availability of essential equipment and medicines for
managing hypertension at all levels of care.
• Target 8 of the global action plan acknowledges the need
to improve the availability of affordable BP machines and
medicines for the poor.
26
• Target 9 of the global action plan is an 80% availability
of affordable basic technologies and essential medicines,
including generics, required to treat major NCDs in public
and private facilities.
26
• Access to affordable and good-quality drugs for hypertension
is important for all LMICs, and especially SSA.
26
– Governments and societies should be willing to prioritise
hypertension control and provide low-cost BP machines
and medications.
– PASCAR and national cardiac and hypertension societies
have adopted a hypertension treatment algorithm,
suggesting the use of high-quality antihypertensive
medications (Fig. 2).
– The ongoing randomised clinical trial, Comparing Three
Combination Therapies in Lowering Blood Pressure in
Black Africans (Creole), will provide more evidence-
based information on the most efficacious of three ‘free’
combinations of two antihypertensive agents on 24-hour
ambulatory systolic BP.
27
– PASCAR has defined minimum standards for BP
machines and drug availability and affordability to control
hypertension in Africa (Table 3).
– PASCAR and national cardiac and hypertension societies
should strongly advocate making antihypertensive
medica-tions available and more affordable to patients.
– Governments should encourage adding to and periodically
updating the hypertension medications on their national
essential medicine list.
– Governments should subsidise the cost of and remove
import duties on these essential medications.
– Governments should put in place an efficient, highquality
monitoring process of medicines.
– Donor organisations and pharmaceuticals should be
engaged in making these medications affordable.
– PASCAR will regularly measure the proportion of the
population with access to affordable, essential drugs in
sentinel sites.
8. Provide universal access and coverage for detecting, treating
and controlling hypertension.
• There are proven cost-effective lifestyle and medical
interventions to prevent and manage hypertension. However,
in Africa, uptake is still unacceptably low.
3
• Universal health coverage will be the main step forward
to ensure that persons with hypertension have access to
effective, affordable and accessible care.
– Governments must have the political will to acknowledge
the hypertension crisis, and the commitment to convince
their parliaments to approve budgets needed for universal
coverage.
– Failure to implement universal coverage may result in
increased healthcare expenditure on the complications of
hypertension.
9. Support high-quality research to produce the evidence that will
guide interventions.
• Data from randomised, controlled trials on hypertension
management are lacking in SSA.
• Research is vital in formulating a sound healthcare policy to
evaluate the performance of interventions in hypertension
control and take managerial decisions in the overall NCD
policy.
28
• Research into hypertension in Africa should be essential,
especially where it can inform resource-allocation decisions.
– Africangovernmentsshouldencourageallmultidisciplinary,
multidirectional and collaborative approaches at national
and international levels, and take a firm commitment to
develop research guided through priority intervention, as
suggested by the WHO.
26
– National cardiac and/or hypertension societies should
take responsibility for identifying research priorities,
building national and international research networks and
partnerships, and advocating for investment in research
to support best practices.
– PASCAR, with its good continental research network,
will continue taking the leadership for research training
and funding while ensuring to develop and sustain
research activities to guide cost-effective interventions for
hypertension control.
10. Invest in population-level interventions for preventing
hypertension, such as reducing salt intake and obesity levels,
increasing fruit and vegetable intake and promoting physical
activity.
• The relationship between BP and the risk of developing stroke
or heart disease is ongoing, starting at a systolic pressure >
115 mmHg.
1
• Hypertension is a preventable cause of morbidity and
mortality.
• High-quality evidence in non-acutely ill adults shows that
reduced sodium intake reduces BP.
29
• These two previous facts highlight the importance of high
risk and population-based strategies in BP management and
control.
– Therefore, advocate for a healthy public policy and large
national programme for hypertension prevention and
control.
– Use national multi-sectoral policies and plans that
specifically address physical activity and nutrition,
including dietary salt, in preventing hypertension and
NCDs.
– Wider implementation of successful governmental
actions including smoke-free policies, marketing of
unhealthy foods and alcohol, sin taxes (e.g. sugar taxes),
and regulation of sodium content in processed foods.
How to adapt the PASCAR 10 actions at country level
This roadmap can be implemented as is or adapted to overcome
local barriers and develop solutions that are more relevant to